13527 POST THIS CARD NEAR FRONT OF BUILDING' PERMIT NUMBEH
CITY OF CUPERTINO 13527
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION JOB ADDRESS 887 FMGROVE DRIVE UNIT# Lor# '
OWNER HARRIET
PERMIT EXPIRES IF WORK
FREID CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
e ANCE OR 180 DAYS FROM
UFER I I� LAST CALLED INSPECTION.
. C.
PREGUNITE
PERMIT VALIDATION
-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED O f, - - ^✓
UNDERGROUND /SLAB /
PLUMBING v
ELECTRICAL L ISSUAN DATE
MECHANICAL BLDG. •T. vLc. MECH.
({� ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR '
PLUMBING VALUATION v + $/FT.
c-
MECHANICAL
ELECTRICAL - - PERMITT��
FRAMING � � r l
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
l"t'\ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
�/✓��,�, ROOF SO.IT.FLOOR AREA TOTALACREAGE
�� DIAPHRAGM
IID
RES' IND CON USE Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED L] ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST
TRACT NO. PARS LNO.
� � � ,
MECHANICAL' -
ELECTRICAL FINALS DATE INSP. ACO DATE ACC FILE NO.
FRAMING SAN # '
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS \
MECHANICAL , FIRE SPRINK ENERGY hZA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
.
LATH—INTERIOR � ELECTRICAL FLOOD ZONE AL.U.C.
LATH—EXTERIOR FIRE DEPT. '�' Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDINGBUILDING 'p .�
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK .
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE r
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILD ING'INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
��. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL {
CALLING FOR FINAL INSPECTION.
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BOILDING APPLICATION & PERMIT
AooRe55T I FFIt iva)z o✓e h rl. 13527
g BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
144rt K 1 kFT 1=r(F-A
PHONE
`
CONTRACTORS
NAMEOUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4.00
ADURE
PHONE PANELS 10.00 DATE OF APPLICATION
AR°RrtEcr PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C.NO.
OR
ENGINEER
, ua NO. ISIGNS TRANS. 3.00
noo"dEss ENc. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT
r$
AO MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 C
woo LICENSED CONTRACTORS DECLARATION // 7 /a 7
a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE/
(commencing with Section 7000)of Division 3 of the Business and rn< ,An BLD ELECT. PLG. MECH.
r• D z License ons Code,and my license is in full lone and of@ct. I
2 0„v( - License Class Liu.Number r i J w11 E:1
o m �� Date Contractor
ar Y f p(N LDING PERMIT
Ix ¢ a OWNER-BUILDER DECLARATION FORMATION
K
N I hereby affirm that I am exempt from the Contractor's List. MISC.- REFER TO ORD
aa .. o a Law for the following reason.(Sec.7031.5,Businessand Professions pERMI'f ISSUANCE 10.00 VALUATION s/FT.
,ate Code:Any city or county which requiresa permit toconstrucLaltcq p�
e, Q 2O improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC.
O¢ requires the applicant For such permit to file a signed statement that TOTAL PERMIT
E
$ he Is licensed pursuant to the provisions of the Contractor's License
z a Low(Chapter 9(commencing with Section 7000)of Division 3 ofthe
5 4 O Business and Professions CWC)or that he is exemtherefrom and therefroand QTY. PLUMBING PERMIT .FEE
H 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; by any applicant for a Permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).) ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employevs with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
[heir sole compensation,will clothe work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
i.� Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 60.FT.FLOOD AREA TOTAL ACREAGE
�.a himself or through his own employees,provided that such improve-
GAS-EA.SVSTEM-11NC.40UTLETS 6.00
thentsare no(intended or offered for sale.If,however,the budding
. +` or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did nut build or im. BUILDING USE
prfor purpose o(sale.). RES. IND CON PB Other
1,us owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 0 ❑ 0 ❑ 0
lic ud contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.DO ASSESSORSPARCELNO.
and Professions Cale:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licenxd pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt antler Sec. ,B.&RC.Ort this WATER HEATER W(VENT 6.00
rea50n
1< Owner Date nL WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK F-RS'COAIPENSA'f1ON DECLARATION WATER TREATING EQUIP, 5.00
1hereby atfi m that I have a certificme of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance or a certdicd
copy Ihereof(Sec.3800,Lsb.C.).
Policy No. Company
U 0 Certified copy is hereby furnished.
FIRE SPR INK ENERGY T14
Z Z ❑ Certified copy is fled with the city impection'divisioa MISC.- REFER TO ORD. Y N V ❑ N[
APPlicunt
~ U) PERMIT ISSUANCE 10.00
� CERTIFICATE UP EXEMPTION PROM WORKERS' FLOOD ZONE AL.0 c.
W > COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL V N� V IN
Z hundred dollurs(SIW)or kss)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL V- mit is issued,I shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California. BUILDING 3a S 8
Date Applicant ALTER OR ADD TO MECH. 5.00
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emplion,you should become subject to the Workers'Compenmtion APPLIANCE 5.00 PLAN CHECK Z
provisions of the labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE
CONSTRUCT ION LENDING AGENCY - AIR HANDLING UNIT(OVER 10100DCENL) 6.00 SEISMIC FEE
I hereby affirm [bat mere is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this pernot is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
O information 0 correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
�., hereby entiorim roprrtyfor ins o! this city es enter upon the BOILER-COMP(Oxer 1DO,000 BTU)SEE FEE SCH. MECHANICAL
^,I above-mentioned property for of this
puity to
s 7 (We) agree to save, indemnify and keep harmless the City of - MISC.- REFER TO ORD.
Cupertino against Kabilitins,judgments, vols and exfmnseo which CONST.TAX
may In any way accrue,against said City in conuquence of the PERMIT ISSUANCE 10.00
grunting Of this permit, MECH.CONT, LIG NO. MECH.
�.W d , k� TOTAL TOTAL �1
S1gna[ure of Applicant/Contractor DWe
OFFICE COPY